Medical Group, Contract Definition Analyst

Experian is a global data and technology company, powering opportunities for people and businesses around the world. We operate across a range of markets, from financial services to healthcare, automotive, agribusiness, insurance, and many more. Experian invests in people and new advanced technologies to unlock the power of data. We have an amazing team of 25,200 people in 32 countries.

About the role

As the Medical Group Contract Definition Analyst, you are responsible for analyzing, implementing, and maintaining professional payer contracts within Experian Health's Contract Manager system. You will apply knowledge of professional reimbursement methodologies and payer policies to model contract terms and support valuation of medical group claims and patient estimates.

Responsibilities

• Analyze, define, and model medical group contracts for Medicare, Medicaid, Workers' Compensation, Medicare Advantage, Managed Medicaid, and Commercial Payers.
• Interpret payer contracts, fee schedules, reimbursement provisions, and supporting documentation for accurate system configuration.
• Apply professional reimbursement methodologies, including RBRVS, fee schedules, carve-outs, drug, DME, and laboratory pricing.
• Research CMS, state Medicaid, and commercial payer resources to understand reimbursement policies, claim processing guidelines, and payer edits.
• Validate and troubleshoot claim and estimate valuations, research discrepancies, and resolve issues.
• Respond to valuation-related support cases within established timeframes.
• Participate in client and internal meetings to clarify contract requirements and resolve issues.
• Contribute to quality and process improvement plans while maintaining current knowledge of evolving reimbursement methodologies and payer policies.

Requirements

• 4+ years' healthcare industry experience involving professional/medical group payer contracts, reimbursement, billing, claims management, or adjudication.
• 4+ years' knowledge of professional reimbursement methodologies, including RBRVS and physician fee schedules.
• 4+ years' experience with carve-outs, drug, DME, and laboratory pricing and payer-specific reimbursement arrangements.
• 4+ years' experience with claim processing guidelines, payer edit policies, and professional coding conventions, including CPT, HCPCS, modifiers, place of service, and ICD-10 diagnosis codes.
• 4+ years' advanced Excel expertise (can perform complex functions).
• Bachelor's degree in Healthcare Administration, Business Administration, or a related field is beneficial.
• Experience with Contract Manager or similar healthcare contract modeling applications.

Benefits

• Great compensation package and bonus plan.
• Core benefits including medical, dental, vision, and matching 401K.
• Flexible work environment, ability to work remote.
• Flexible time off including volunteer time off, vacation, sick, and 12 paid holidays.

Explore all our exciting benefits here.

Pay

Salary range: $63,964 - $110,872. Within this range, individual pay is determined by work location and additional factors such as job-related skills, experience, and education. You will also be eligible for a variable pay opportunity.